1013910793 NPI number — PREMIER SUPPORT SERVICES, INC.

Table of content: (NPI 1013910793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013910793 NPI number — PREMIER SUPPORT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER SUPPORT SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INTERIM HEALTHCARE OF EAST TENNESSEE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013910793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2482 BRIGHTS PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37814-6315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-587-8771
Provider Business Mailing Address Fax Number:
423-587-8773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2482 BRIGHTS PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37814-6315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-587-8771
Provider Business Practice Location Address Fax Number:
423-587-8773
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RAY
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
423-587-8771

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  0000000010 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 372500000X , with the licence number: L000000006169 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0447404 . This is a "TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3162461 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4261896 . This is a "VOLUNTEER STATE HEALTH PLAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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